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目的:探讨膀胱全切术后理想的膀胱替代术式。方法:14例膀胱肿瘤患者行膀胱全切后,采用回肠折叠成“W”形或“U”形成贮尿囊与后尿道吻合,尿液经原尿道排出的正位回肠膀胱重建术治疗。结果:围手术期无1例死亡,随访0.5～6.0年,膀胱容量220～460ml,平均380ml;膀胱充盈压1.27～4.41kPa(平均2.94kPa);最大尿流率12～20ml/s(平均18ml/s);新膀胱排尿功能良好,除2例有轻度尿失禁,3个月后自行恢复控尿;2例出现上尿路积水,间断自我导尿后好转;血电解质显示5例患者血清Cl-偏高,但无酸中毒发生,血清肌酐、尿素氮检测值均在正常范围。结论:正位回肠膀胱重建术是较理想的膀胱替代术式。
Objective: To investigate the ideal bladder replacement after total cystectomy. Methods: Fourteen patients with bladder cancer underwent complete urinary bladder resection. The ileum was folded into “W” shape or “U” Surgery. Results: Perioperative deaths were not observed in one patient. The follow-up ranged from 0.5 to 6.0 years. The bladder volume was 220-460 ml (average 380 ml), the bladder filling pressure was 1.27-4.41 kPa (average 2.94 kPa) and the maximum flow rate was 12-20 ml / s / s); urinary bladder function was good, with 2 cases of mild urinary incontinence, 3 months after the resumption of urine control; 2 cases of upper urinary tract hydronephrosis, intermittent self-catheterization improved; blood electrolyte showed 5 patients Serum Cl- high, but no acidosis, serum creatinine, urea nitrogen values ?? are in the normal range. Conclusion: Posterior ileal bladder reconstruction is an ideal bladder replacement surgery.